Actuarial Incidence and Pattern of Occurrence of Shocks Following Implantation of the Automatic Implantable Cardioverter Defibrillator

Fogoros, Richard N.; Elson, James J.; Bonnet, Christopher

doi:10.1111/j.1540-8159.1989.tb06151.x

Cited by 138 publications

(34 citation statements)

References 10 publications

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“…Electrocardiographic documentation at the time of ICD shock was not available for all patients. However, the criteria for appropriate shock used in our study are in accordance with criteria used by other investigators [3, 8, 9, 14]. The fact that our data regarding shock incidence are similar to the results of other investigators [15, 16], ranging from 62 to 69% in 5 years, make it unlikely that we overestimated the incidence of appropriate shocks.…”

Section: Discussionsupporting

confidence: 76%

“…All patients were seen routinely every 1–3 months or after each device discharge. An appropriate shock by the cardioverter-defibrillator was defined as a discharge preceded by symptoms of severe light-headness, presyncope, syncope followed by immediate relief from these symptoms [9], or a discharge for ventricular tachycardia or ventricular fibrillation as documented by stored cycle lengths or stored electrograms. Inappropriate device discharges were excluded from the analysis.…”

Section: Methodsmentioning

confidence: 99%

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Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators

Anvari

Gottsauner‐Wolf²,

Türel³

et al. 1998

Cardiology

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This study determined the impact of clinical characteristics on shock occurrence and survival in patients with implantable cardioverter-defibrillator (ICD). Methods and Results: During a follow-up of 27 ± 18 months, the actuarial incidence of appropriate shocks in 200 consecutive patients was 18, 36 and 72% at 1, 3, and 5 years, respectively. Coronary artery disease was the only significant predictor for shock occurrence (relative risk 1.32, p = 0.03). The actuarial incidence of total mortality was 10, 17 and 33% at 1, 3, and 5 years, respectively. The most powerful predictors for total mortality were: New York Heart Association functional class (NYHA) III (relative risk 4.8, p = 0.001) and a history of congestive cardiac failure (relative risk 3.6, p = 0.01). Conclusion: During long-term follow-up, the majority of patients receive appropriate shocks. No strong predictors for shock occurrence can be identified from the data analyzed. A history of congestive cardiac failure and the NYHA III are the most powerful predictors for total mortality. These clinical factors may provide valuable criteria to identify patients who will benefit from the implantation of ICD.

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Section: Discussionsupporting

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators

Anvari

Gottsauner‐Wolf²,

Türel³

et al. 1998

Cardiology

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“…2,3 With "shock-only" devices, the incidence of these events during long-term follow-up has ranged between 16% and 21%. 16,17 Fromer et al 18 reported inappropriately detected episodes in 10 of 102 patients with implants during an average follow-up period of 9.4 months. In the present study, 116 of the 778 patients with implants or of the 294 patients with a therapy delivered experienced inappropriate episode detection followed by a therapy, despite a short follow-up time.…”

Section: Inappropriate Therapymentioning

confidence: 99%

Adverse Events With Transvenous Implantable Cardioverter-Defibrillators

et al. 1998

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on behalf of the European 7219 Jewel ICD InvestigatorsBackground-A newly developed classification system relates adverse events to the surgical procedure or the function of the implantable defibrillator. Methods and Results-Adverse events were monitored during prospective clinical evaluation of the Medtronic model 7219Jewel ICD and were classified according to the definitions of the ISO 14155 standard for device clinical trials into 3 groups: severe and mild device-related and severe non-device-related adverse events. In addition, events were related to the surgical procedure, treatment with the device, or cardiac function. Seven hundred seventy-eight patients were followed up for an average of 4.0 months after ICD implantation. In total, 356 adverse events were observed in 259 patients. At 1, 3, and 12 months after ICD implantation, 99%, 98%, and 97% of the patients, respectively, survived; 95%, 93%, and 92%, respectively, were free of surgical reintervention; and 79%, 68%, and 51%, respectively, were free of any adverse event. Twenty patients died: 6 deaths were related to the surgical procedure, 12 deaths were considered unrelated to ICD treatment, and 2 patients died of an unknown cause. Of 111 nonlethal severe adverse device effects, 47 required surgical intervention, 19 times for correction of a dislodged lead. Inappropriate delivery of therapy was observed 128 times in 111 patients, and the events were typically resolved by reprogramming or drug adjustment. Nine of these required rehospitalization. Conclusions-Approximately 50% of patients experience an adverse event within the first year after ICD implantation.The observed adverse event rate depends on the definitions and the prospective monitoring. The incidence of inappropriate therapy emphasizes the need for improved detection algorithms and for quality-of-life evaluations, especially when considering ICD treatment in high-risk but arrhythmia-free patients. (Circulation. 1998;98:663-670.)

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“…Circumstances of shock delivery were evaluated, and number of discharges while the patient was on the waiting list was documented. Appropriate shocks were defined as previously described by Fogoros et al 19 as spontaneous ICD discharges preceded by symptoms of severe lightheadedness, presyncope or syncope, or shocks for ventricular tachycardia or ventricular fibrillation as documented by Holter monitoring or stored ECGs by the device.…”

Section: Follow-upmentioning

confidence: 99%